Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis

Abstract

Aim: To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites.

Methods: An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates.

Results: Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence.

Conclusions: Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.

Keywords: alveolar ridge preservation; extraction; molar; periodontally compromised; periodontitis; systematic review.

Figure A1

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the width of the alveolar ridge at (a) mesial-quarter ridge at 1 mm level below the ridge crest, (b) distal-quarter ridge at 1 mm level below the ridge crest, (c) distal-quarter ridge at 3–4 mm level below the ridge crest, (d) mesial-quarter ridge at 5–7 mm level below the ridge crest, (e) mid-ridge at 5–7 mm level below the ridge crest, and (f) distal-quarter ridge at 5–7 mm level below the ridge crest. p = .: p value not computed for subgroup.

Figure A1

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the width of the alveolar ridge at (a) mesial-quarter ridge at 1 mm level below the ridge crest, (b) distal-quarter ridge at 1 mm level below the ridge crest, (c) distal-quarter ridge at 3–4 mm level below the ridge crest, (d) mesial-quarter ridge at 5–7 mm level below the ridge crest, (e) mid-ridge at 5–7 mm level below the ridge crest, and (f) distal-quarter ridge at 5–7 mm level below the ridge crest. p = .: p value not computed for subgroup.

Figure A1

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the width of the alveolar ridge at (a) mesial-quarter ridge at 1 mm level below the ridge crest, (b) distal-quarter ridge at 1 mm level below the ridge crest, (c) distal-quarter ridge at 3–4 mm level below the ridge crest, (d) mesial-quarter ridge at 5–7 mm level below the ridge crest, (e) mid-ridge at 5–7 mm level below the ridge crest, and (f) distal-quarter ridge at 5–7 mm level below the ridge crest. p = .: p value not computed for subgroup.

Figure A2

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the alveolar ridge height at (a) mesial-buccal, (b) mesial-oral, (c) disto-buccal, and (d) mid-central sockets. p = .: p value not computed for subgroup.

Figure A2

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the alveolar ridge height at (a) mesial-buccal, (b) mesial-oral, (c) disto-buccal, and (d) mid-central sockets. p = .: p value not computed for subgroup.

Figure A3

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the alveolar ridge height at (a) mesial-central, (b) distal-central, and (c) distal-oral sockets. p = .: p value not computed for subgroup.

Figure A3

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the alveolar ridge height at (a) mesial-central, (b) distal-central, and (c) distal-oral sockets. p = .: p value not computed for subgroup.

Figure 1

Flowchart illustrating the search strategy and selection process (PRISMA2020).

Figure 2

Risk of bias assessment. Quality assessment for RCTs (RoB 2.0).

Figure 3

Risk of bias assessment. Quality assessment for non-randomised controlled studies (Robins-I).

Figure 4

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the width of the alveolar ridge at (a) mid-ridge 1 mm level below the ridge crest, (b) mid-ridge 3–4 mm level below the ridge crest, and (c) mesial-quarter ridge at 3–4 mm level below the ridge crest. p = .: p value not computed for subgroup.

Figure 5

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): changes in the alveolar ridge height at (a) mid-buccal and (b) mid-oral sockets. p = .: p value not computed for subgroup.

Figure 6

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and NCTs): alveolar ridge volumetric change.

Figure 7

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): change in keratinised mucosal width.

Figure 8

Alveolar ridge preservation versus spontaneous healing. Subgroup analyses (RCTs and CCTs): need for additional sinus procedure or augmentation at the time of implant placement: (a) maxillary and mandibular molars and (b) maxillary molars only.